Factors impacting outcomes in individuals ≥80 years with non-small cell lung cancer (NSCLC): A national cancer database (NCDB) analysis.
Authors: Ethan Burns, Sunil Mathur, Ryan Blair Kieser, Wan Hsiang Chen, Eric Bernicker
Journal: Journal of Clinical Oncology (2023)

9043 Background: Older individuals with advanced/metastatic NSCLC have inferior outcomes compared to younger patients. Aside from baseline comorbidities and treatment-limiting toxicities, identifying factors that impact overall survival (OS) in this population is needed. The aim of this study is to assess characteristics impacting outcomes in patients ≥80 years with NSCLC using the NCDB. Methods: Adults ≥80 years with NSCLC, stage III/IV disease, diagnosed between 2015-2018, and available demographic data were included. Age, sex, race, insurance status, hospital subtype, Charelson-Deyvo comorbidity (CDCC) index, cancer stage (III/IV), geographic region in the United States (US), and histologic NSCLC subtypes were compared. Kaplan-Meier methodology assessed differences in median OS, and differences were compared using hazard ratios (HR) with 95% confidence intervals (CI). Pearson Chi-Squared test assessed the significance of covariates, and a p value &lt; 0.05 was considered statistically significant. Results: There were 42,356 patients included. Median age was 83 (80-90) years, 20,422 were (48.2%) female, 35,653 (84.2%) were white, 37,738 (89.1%) had medicare coverage, 11,055 (26.1%) received treatment at an academic hospital, and 14,383 (33.9%) received care in the southern United States. Treatment at an academic hospital (HR: 0.91 [95% CI: 0.87, 0.95], p &lt; 0.001), females (HR: 0.82 [95% CI 0.81, 0.84], p &lt; 0.001), Medicaid (HR: 0.77 [95% CI: 0.65, 0.93], p = 0.005) vs no insurance, and adenocarcinoma (HR: 0.79 [95% CI: 0.74, 0.84], p &lt; 0.001) or squamous cell carcinoma (HR: 0.84 [95% CI: 0.80, 0.90, p &lt; 0.001] had better outcomes. Patients in the Northeastern (HR: 0.90 [95% CI: 0.87, 0.93], p &lt; 0.001), Southern (HR: 0.92 [95% CI: 0.89, 0.94], p &lt; 0.001), and Western (HR: 0.89 [95% CI: 0.88, 0.93], p &lt; 0.001) US had better OS compared to the Midwest. Compared to whites, patients who were black (HR: 0.92 [95% CI: 0.88, 0.85], p &lt; 0.001), Asian (HR: 0.77 [95% CI: 0.72, 0.82], p &lt; 0.001), Hispanic (HR: 0.83 [95% CI: 0.78, 0.88], p &lt; 0.001), or other (HR: 0.88 [95% CI: 0.79, 0.97) had better outcomes. Per year increase in age (HR 1.009 [95% CI: 1.006, 1.013], p &lt; 0.001), patients with CDCC score of 1 (HR: 1.16 [95% CI: 1.14, 1.19], p &lt; 0.001), 2 (HR: 1.22 [95% CI: 1.18, 1.27], p &lt; 0.001), and ≥3 (HR: 1.33 [95% CI: 1.284, 1.380], p &lt; 0.001) vs 0, and stage IV NSCLC (HR: 1.83 [95% CI: 1.79, 1.88], p = 0.000) had poorer survival. Conclusions: White race, males, uninsured status, receipt of treatment in the Midwest, community hospital treatment, large cell histology, advancing age, stage IV disease, and increasing CDCC score all had poorer outcomes in adults ≥80 years with advanced NSCLC. These factors should be taken into consideration when discussing the diagnosis, management, and expectations of the disease course with patients in the geriatric age group.